February/March/April 2016 - IVF #2, Androgen Priming

The break we took from (most of) it in February was nice.  I had a couple weeks of business trips and a baby shower to throw for a friend.  February was busy enough without all the shots and doctor visits.  I needed the time to get my attitude in the right place for starting over again.  I did continue with the acupuncture, natural supplements, and fun-free diet...figured it was easier to keep it going than go back and forth, and hopefully help more along the way.

February was the month of the most pills I have ever consumed.  From the time of my retrieval to the time I started the next phase in March, I was taking 25 pills / day as directed by my RE and acupuncturist.  Most of these were supplements, or herbs.  Here's an outline:

• Prenatal + DHA vitamin (2 pills)
• 4000 IU vitamin D (2 pills)
• Baby aspirin (1 pill)
• Chinese detox herbs (9 pills)
• Antioxidant supplement (3 pills)
• L-Argenine supplement (3 pills)
• Ubiquinol (2 pills)
• DHEA (2 pills)
• Royal Jelly (1 pill)

The detox herbs were great, and temporary, so those dropped off when I started the next step in March, bringing the total down to 16 pills before the RE added in a couple new ones...

This is the thing that keeps me from screwing up with the timing of all the pills each week!

Note: this just holds 1 week's worth of pills...

We met with the RE during the middle of my February cycle just to talk strategy and see what else he would recommend doing now that we've seen all the data from our first cycle.  He recommended an approach he said has been proven successful with low ovarian reserve patients in the recent past.  Since estrogen levels are already very low for me, instead of starting everything off with a week of birth control to calm the system down, we would start the cycle with 3 weeks of "androgen priming" to "charge the ovaries up" and help them respond more readily to the meds.  He then recommended a Menopur only "stim" protocol, combining with the Cetrotide part way through, and then concluding with a double "trigger" shot (Ovidrel) before retrieval.  The round #2 would look like this:

• Day 1 - Baseline blood tests and ultrasound when I start my next period; initiate Estrogen (Estrace) and Progestin (Aygestin) pills at that time
• Day 6 - Start applying Testosterone cream (Androgel, 12.5mg/dl) daily (yes, you read correctly, testosterone cream!)
• Continue for 21 days of pills (ending Day 21) and 21 days of testosterone cream (ending Day 27)
• Day 26 - Blood tests and ultrasound prior to starting shots of Menopur (600 IU daily)

Coming in for the first set of blood tests and ultrasound was a little emotional for me.  It meant we were really starting over, not that I had doubts about doing it.  Not at all.  It just meant that starting meant that we would have to go through the roller-coaster again and the end result would be another potential for disappointment.  I must admit, I was struggling to find my optimism...I felt very apprehensive about getting any sort of hopes up for this round.  I was pretty jolted by round #1 and going from 5 embryos to 1.  Being hopeful seemed like a dumb move, just setting myself up for more disappointment, but I knew being positive was a pretty essential ingredient to making it through the whole process again...and this was going to be an extra looooong process with this 27 days of priming before we even get to start with the shots.  It would be especially long if I have to learn to shave my face / chest during that time, too!  LOL!

I reached out to a few friends who had also been down this road of multiple cycles, all of whom have beautiful babies now.  They sent me pictures and told me I must be positive about it.  They said to look forward to the fact that we know what we are doing, the second round will be easier, even just because you know what to expect.  Keep your eyes on the prize, they said.  Everything you go through is worth it in the end.  It's ok to get your hopes up, because it's so much harder to get through it all without that hope!

Feeling moderately better, and focusing on my positive thinking, we jumped into round #2.  My daily pill count was at 18, and the Estrace and Aygestin were giving me daily nausea.  Yuck.  Bad enough that I stayed home here and there just so I could be near the bathroom.  The testosterone cream was interesting.  It comes as a cream in a pump container, and 1 pump = 1 daily dose.  It had to be sent to a special compounding pharmacy that mixes it to the right dosage.  It sat ominously on my counter top alongside the pill dispenser for about a week until Day 6 arrived.  Day 6 came on March 11 and I took my first dose of testosterone cream.  I felt...the same.  I really hadn't expected the uneventful part of the "priming" phase to be the testosterone.

The 21 days of pills came and went along with waves of nausea, some days better than others.  It drug along and at a few points I wished I could just sleep through the rest of it and wake up on the other side.  For the record, it's not much fun to have the nausea of pregnancy without the actual excitement of the pregnancy!  As we closed in on the 3rd week of testosterone cream, I found myself really wound up about some very silly things.  Twice, I almost went off on people on Facebook.  One was a person posting blatantly false information to conveniently support their political agenda...the other was a set of neighbors who wanted to create and sell commemorative t-shirts lauding their "survival" of the construction of the Grand Parkway (for those who don't know, the GP is a big, modern highway near our neighborhood, one that many other countries would die to have as infrastructure...it was a mild inconvenience for about 2 years before it opened, but the complaining and vitriol that spewed forth from our neighbors would have made you think it was the end of the world! In that moment, I had had enough.).  I rarely would get wound up about either of these enough to reply, regardless of how silly / irritating they might be, and here I was composing very firm responses to each of them, determined to set things right.  Michael stopped me...both times...not worth it at all to respond...it won't change their minds...they are not open-minded individuals, you know this...but I was fuming!  What has gotten into me?  Testosterone!  The rage is real, people!  I also got pulled over for speeding, but thankfully was let off with a warning...

Seriously...why isn't it ever anything good?  My suggestions:
"Makes doing mundane tasks enjoyable" or "May help you lose that 10lbs"

March 31, the last day of the testosterone cream was the day I went back into the office for the clearance check (blood tests and ultrasound) before starting shots.  As they saw at the beginning of March (and also the beginning of the January cycle), I had a medium sized cyst (15mm diameter) on my right ovary.  It hadn't changed size since early March, and appeared to be adjacent to the ovary instead of inside of it, so this was apparently not cause for concern or delay.  The blood tests came in that afternoon and the RE said I was clear to start shots on Friday, April 1.  Hopefully not a foolish decision! Nyuk nyuk...